Audit Strategy Research Articles

Article: Tax Competition and the EU Anti-money Laundering Regime

Member States engage in tax competition to expand their tax bases thereby risking a ‘race to the bottom’ in corporate tax revenues. The global minimum tax under Pillar Two is expected to contribute significantly to curbing this practice. Assuming that minimum taxation eliminates competition in statutory tax rates, tax competition is likely to continue. This is because countries then lower their effective tax rates by reducing tax enforcement. As audit strategies, unlike statutory tax rates, are not publicly observable, other countries cannot easily observe and can never verify them. However, countries reducing their tax enforcement adhere to a policy that implicitly encourages tax evasion. Hence, enforcement and observability problems can also be addressed indirectly by targeting their outcome – tax evasion. In most Member States, tax evasion is a predicate offence for money laundering that effectuates a very effective EU anti-money laundering (AML) regime. Its instruments cannot only serve as a tool to adequately address foreign tax evasion but also to reveal, monitor, and control, at least indirectly, other Member States’ efforts in the fight against tax evasion. AML legislation can therefore help to close a still unnoticed loophole in curbing tax competition that will not be addressed by introducing minimum taxation. Tax competition, money laundering, tax evasion, tax avoidance, tax enforcement, predicate offence, dual criminality, FATF, AMLA

Discussion on the Innovation Strategy of Enterprise Internal Audit under the Big Data Environment

Discussion on the Innovation Strategy of Enterprise Internal Audit under the Big Data Environment

Audit and feedback in cardio- and cerebrovascular setting: Toward a path of high reliability in Italian healthcare.

Adopting audit and feedback (A&F) strategies could be a suitable healthcare intervention to fulfill the challenge of monitoring and improving clinical guidelines in evidence-based medicine. Indeed, A&F is used to encourage professionals to better adhere to standard guidelines to improve healthcare performance. Briefly, an audit is an inspection of professional practice in comparison to professional standards or targets whose results are subsequently communicated to professionals in a structured manner. Although A&F strategies have been adopted in several time-dependent settings, such as for acute myocardial infarction (AMI) and stroke, interest of audits in rehabilitation care is also emerging. Recently, the Italian Ministry of Health has funded a national network project called EASY-NET, whose main objective is to evaluate the effectiveness of A&F strategies to improve healthcare practice and equity in various clinical and organizational settings in seven Italian regions. Last but not the least of these regions is the Sicily, represented within the project by the IRCCS Centro Neurolesi Bonino-Pulejo of Messina as the work package 7 (WP7). The EASY-NET WP7 is focused on the effectiveness of A&F strategies in both AMI and ischemic stroke setting, from acute to rehabilitation process of care. In this study, we described the study protocol, including the study design and methodology, providing a detailed description of the new model of A&F based on telemedicine, and discussing the possible challenges of this project.

Strategy Management of PT Agrapana Wukir Panca in Building Business Collaboration

The business concept now no longer uses independent thinking but has evolved into independence. Where business is not only and always leads to competition but also leads to collaboration. Business collaboration is the optimal choice in carrying out strategic management. PT Agrapana Wukir Panca is a company whose legalization status is still in the form of a Trade Unit. This study aims to find out how strategic management is applied at PT Agrapana Wukir Panca in building business collaboration. The research method used in this study is a library research method with a qualitative approach. The data is obtained from sources from articles, books, reports, and other research on strategic management and business collaboration. The results of the study found that the strategic management of PT Agrapana Wukir Panca which was applied in building business collaboration through three stages. First, the formulation of an audit strategy based on the company's mission and objectives. Both strategy implementations are based on effective resource allocation. And third, evaluate the strategy by monitoring.

Study on the Performance Optimization Algorithm Strategy of Resource and Environment Audit Based on Computer Network Technology

In order to better control and repair resource and environmental problems, the state has invested a lot of manpower, material resources, and funds and issued corresponding ecological and environmental protection measures. As the national environmental supervision mechanism, the resource and environmental audit department is responsible for the supervision of national environmental governance. With the continuous development of computer technology, it brings convenience to resource and environment audit and improves the extraction of data processing, storage, and processing capacity. Because there are many departments involved in resource and environment audit, the cooperation between different departments will inevitably have errors. Using computer technology to mine the relevance of relevant data is conducive to the cooperation between departments. This study builds relevant algorithms and uses new technologies to collect data so as to improve the efficiency of audit work and better promote the construction of ecological civilization.

Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews.

BackgroundThe underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception.ObjectiveThis study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured.MethodsWe performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis.ResultsOf the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level.ConclusionsClinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.

Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. MAIN STATEMENTS 1: GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2: ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3: ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4: ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5: ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6: ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7: ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8: ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9: ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10: ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.

Competitive Analysis for the Auditing Cloud Consistency

Cloud storage is one of the service of cloud comput- ing. Cloud storage services are commercially popular because to their advantages. It allows data owners to move data from their local computing systems to the cloud. It offers high quality and on-demand data storage services to users. A cloud is essentially a large-scale distributed system; each piece of data is replicated on multiple geographically distributed servers to achieve high availability and high performance. A cloud service provider (CSP) keeps multiple replicas for user’s data on geographically distributed servers. A main problem of using the replication technique in clouds is that it is very expensive to achieve strong consistency on a worldwide scale. In this paper, we are reviewing consistency as a service (CaaS) model, a two-level auditing architecture and a heuristic auditing strategy (HAS) that reveals as many violations as possible.

What works to improve school lunch nutritional quality - legislation or self-audit?

Sweden updated its legislation on universal free school meals in 2011 and nutrition was explicitly mentioned. This study i) describes cross-sectional changes in school lunch nutritional quality during the following eight years, and ii) examines if repeated self-auditing, using a fully automated, online tool (School Food Sweden), based on the implementation strategy of audit and feedback, was associated with improvements. Both repeated cross-sectional and longitudinal design. Factors associated with meeting nutritional criteria were examined using variance weighted least squares regression and logistic regression. Sweden. Primary schools who self-selected to audit meal quality between March 2012 and July 2019. Almost half of all (ca 4800) primary schools signed up to use the tool, and 1500 audited nutritional quality at least once. Repeated cross-sectional analyses showed the proportion meeting the nutritional criteria increased significantly between 2012/13 (11%) and 2018/19 (34%). Longitudinally, each additional audit completed increased the odds of meeting the nutritional criteria by 1.30 (CI 1.20-1.41), controlling for region and time elapsed since the legislative change. In 774 schools with repeat audits, both number of audits and frequency of accessing feedback predicted meeting the nutritional criteria (OR 2.02, CI 1.23-3.31), even after adjusting for time since the legislative change and days elapsed since previous audit. Both legislation and self-audit with automatic feedback appear effective in helping schools to improve school meal quality. Self-audit with feedback may be an effective complement to legislation, or a promising alternative in settings where regulation is not an option.

RISK MITIGATION STRATEGIES AND PERFORMANCE OF INSURANCE INDUSTRY IN KENYA: A CASE OF MOTOR INSURANCE COMPANIES

Purpose: The study’s general objective was to establish the effects of risk mitigation strategies on performance of insurance industry in Kenya: a case of motor insurance companies. Specifically, the Project focused on the Risk control, risk avoidance, risk transfer and product mix strategies on performance of the insurance industry 
 Methodology: The research used descriptive survey research designs. The target population of this study was the management and the other employees of all the 18 Motor insurance companies, the sample size of the study was 54. The sampling procedure was both simple random sampling and purposive sampling. Primary data entailed using of questionnaires. Content validity was ensured by asking questions that are relevant and captured the research objectives, reliability was measured with the help of Cronbach’s alpha (α). Descriptive statistics such as means, standard deviation and frequency distribution tables were used to analyze the data. Qualitative data was analyzed using content analysis to generate qualitative reports which were presented in a continuous prose. Inferential statistics such as regression and correlation analysis were used to establish the effects of risk mitigation strategies on performance of insurance industry in Kenya, a case of motor insurance companies. Data presentation was done by the use of bar charts and graphs, percentages and frequency tables for ease of understanding and interpretation.
 Results: The study found out that risk control strategy and performance of regulated motor insurance companies in Kenya are positively and significantly related. The results further indicate that risk avoidance strategy and the performance of regulated motor insurance companies were positively and significantly related. It was further established that product mix strategy and performance of regulated motor insurance companies were positively and significantly related while risk-based audit strategy and performance of regulated motor insurance companies were also positively and significantly related
 Unique Contribution to Theory and Practice: The study concluded that risk controlling strategy, risk avoidance strategy, risk-based audit strategy and product mix Strategy have a positive and significant effect on performance of Motor Insurance Companies. Based on the findings and conclusions that risk controlling, risk avoidance Strategy, risk-based audit strategy and product mix strategy has a positive and significant effect on performance of Motor Insurance Companies.
 The study recommended that motor insurance companies should work toward investing more on risk reduction strategies in order to improve their performance.

The Community-Based Child Health Integrated Program in Iran: A Mixed-Methods Process Evaluation

Objectives: The community-based Child Health Integrated Program (CHIP) was established to improve children’s health status in Iran. The current study was performed to understand how this program was implemented and experienced by the care providers and target group.
 Methods: A total number of 249 mothers who had children under 5 years (clients) and 70 caregivers (providers) were selected from 42 health care centers of Tabriz city to participate in the study. Quantitative and qualitative data were collected using two separated semi-structured interviews as well as self-developed questionnaires. The mixed-method process evaluation study was examined and reported the exposure and satisfaction status of the clients, and reach, delivery, fidelity rates, and contextual factors toward the CHIP.
 Results: Overall, low reach (11.2%), moderate-exposure (62.6%), and high satisfaction (80.1%) rates of the clients were reported to the program. The fidelity rate of the program tools was 42.9%, considered as an inadequate rate. Anthropometric measurement and vaccination of the children, as well as face-to-face training sessions for the mothers, were well delivered. However, some parts of the program including follow-up and group training sessions were delivered poorly.
 Conclusions: This process evaluation study demonstrated that the CHIP is a promising intervention for improving children's health care. However, the barriers identified in this study warrant consideration in subsequent health care needs among children. Further research is required to identify ways to improve the implementation and delivery of this intervention.
 Practice Implications: There is a dire need to enter some audit and feedback strategies in the form of monthly tracking of process indicators to extent of implementation of intervention components.

Systems-level audit and feedback interventions to improve oncology care: a scoping review.

Audit and feedback is commonly used as a method of both monitoring and attempting to improve the quality of healthcare. No review has examined the literature on systems-level audit and feedback strategies to improve the quality of oncology care. This scoping review examines the number, care focus (technical, nontechnical, or both) and methodological quality of published intervention studies which have used systems-level audit and feedback intended to improve the quality of care delivered in oncology treatment centers. Medline, Embase, PsycINFO, and the Cochrane database were searched, from inception to March 2021, for intervention studies which examined the effectiveness of systems-level audit and feedback in improving care for cancer patients. Studies which met the Effective Practice and Organization of Care (EPOC) minimum design criteria were then assessed using the EPOC risk of bias tool. Study characteristics and outcomes were extracted for those meeting methodological criteria. A narrative approach was used to synthesize the results. A total of 32 intervention studies met the inclusion criteria, of which 53% focused on technical aspects of care, 31% focused on nontechnical and 16% focused on both. Four of the included 32 studies met the EPOC minimum design criteria (13%). Most studies had a before-after study design (75%; n = 24) and methodological quality of the final four studies was moderate. Audit and feedback studies involving oncology treatment centers have primarily focused on technical care aspects. The low number and moderate methodological quality of the studies make it difficult to draw clear inferences about the effectiveness of systems-level audit and feedback. Furthermore, high-quality audit and feedback interventions are required across technical and nontechnical aspects of care to quantify the effectiveness of strategies for improving cancer care and ensure healthcare resources are being optimized.

The Current Situation and Audit Countermeasures of National Scholarship & Grant-In-Aid for Chinese College Students

With the continuous improvement of China's financial aid for college students, the compliance and legitimacy of the management of National Scholarship & Grant Systems have a great impact on the practical interests of all students. It is essential to establish and improve management systems within Chinese colleges and universities. With the functions of supervision, evaluation, consultation, etc., the internal audit of colleges and universities is the important measure to carry out the management in a fair and public manner. Furthermore, the internal audit is also an important tool to prevent various risks in colleges and universities. This paper firstly analyses the source and structure of National Scholarship & Grant-In-Aid, and puts forward the internal audit strategies accordingly, aiming to providing constructive suggestions for standardizing and improving the management of National Scholarship & Grants.

Tax Audit Administration: Object and Processes a Conceptual Review

This publication is borne out of the necessity to examine the object and processes of Tax Audit programs. This becomes very apt and very timely due to the situation of dwindling government revenue as well as continuous deficit national budget. The major objective of this article is to present a conceptual framework through in-depth review, with a view to projecting the potential revenue that is collectible if the tax audit program is well-articulated. The problem here is the fact that available revenue is no longer sufficient to meet up with the responsibility of governance in Nigeria. The deployment of a tax audit strategy is to an extent dependent on your understanding of ‘tax gap’’ and the attendant peculiarities of nations in the different tax gap categories. The novel approach of this research is found in the fact that no researcher has established any link between tax audit and tax gap. The article has established that the larger the tax gap, the larger the potential for better tax audit yield. The methodology is to deploy an aggressive tax audit program for nations with a wide tax gap for optimal tax revenue yield. The article recommends to the Nigerian government and the government of nations a well-developed, intelligence-based, tax audit program which is automated and implemented by professionally qualified personnel. We conclude by exposing the level of potentiality that is achievable through a knowledge-based tax audit strategy.

Big Data and Big Data Analytics in External Auditing: Motivations and Challenges

Big Data (BD) and Big Data Analytics (BDA) has become an increasing trend all over the world and has gained popularity across various sectors; areas of accounting and auditing are not an exception. Even though there are benefits and optimistic views from experts to the use of BD and BDA in External Auditing (EA), application in real circumstances results in challenges. Therefore, the objective of this study is to examine the motivations and challenges of using BD and BDA in the Sri Lankan EA context. This paper is significant in terms of its objectives of both motivators and inhibitors for the use of BD and its research context of Sri Lanka which is a developing country. The study used a qualitative methodology by employing a general qualitative inquiry approach with the use of multi-perspectival analysis of Big 4 audit firms in Sri Lanka, Audit client companies, respective Regulators, and Professionals for data analytics in Sri Lanka. As per findings, it was evident that the Sri Lankan external auditing industry is still at the start of adopting innovative technologies and changing fast with expanding the usage of innovative tools mainly driven by both internal and external pressures. Using BD to EA is coming from both the demand and supply sides. The most challenging factor for using BDA is the lack of knowledge on BD and BDA of external auditors. The study emphasized the need for audit companies to implement BD driven approach by overcoming the challenges faced and customizing the audit strategy to gain long-term efficiency in the external auditing industry of Sri Lanka.

The effectiveness of canteen manager audit and feedback reports and online menu-labels in encouraging healthier food choices within students’ online lunch orders: A pilot cluster randomised controlled trial in primary school canteens in New South Wales, Australia

Online school canteen lunch ordering systems may offer a unique opportunity to support the implementation of school canteen nutrition polices, while delivering behavioural interventions directly to consumers to influence healthy student purchasing. This cluster randomised controlled trial aimed to test the effectiveness of a menu audit and feedback strategy alone, and in combination with online menu labels in encouraging healthier purchasing from an online school canteen ordering system. Five intervention schools received a menu audit and feedback strategy, plus online menu labels; and five control schools received a delayed menu audit and feedback strategy. Data from 19,799 student lunch orders, containing over 40,000 items were included in the evaluation. Outcomes were assessed at baseline (pre-intervention), follow-up 1 (menu audit and feedback vs control), and follow-up 2 (menu audit and feedback plus online menu labels vs menu audit and feedback alone). From baseline to follow-up 1, the menu audit and feedback strategy alone had no significant effect on the proportion of healthy (‘Everyday’) and less healthy (‘Occasional’ or ‘Should not be sold’) items purchased. From baseline to follow-up 2, schools that received menu audit and feedback plus online menu labels had significantly higher odds of students purchasing ‘Everyday’ items (OR: 1.19; p = 0.019), and significantly lower odds of students purchasing ‘Occasional’ (OR: 0.86; p = 0.048) and ‘Should not be sold’ (OR: 0.52; p < 0.001) items. Menu audit and feedback with the addition of online menu labels was effective in increasing the proportion of healthy items purchased relative to menu audit and feedback in isolation. There may be a greater role for online menu labelling as part of a suite of strategies to improve public health nutrition in schools.

104. Improving Efficiency of Antimicrobial Stewardship Reviews Using Artificial Intelligence Modelling

BackgroundAntimicrobial stewardship programs (ASP) in hospitals improve antibiotic prescribing, slow antimicrobial resistance, reduce hospitalisation duration, mortality and readmission rates, and save costs. However, the strategy of prospective audit and feedback is laborious. In Singapore General Hospital (SGH), 10 reviews are required to identify 2 inappropriate cases. Limited manpower constraints ASP audits to only about 30% of antibiotics prescribed. This proof-of-concept study explored the feasibility of developing a predictive model to prioritise inappropriate antibiotic prescriptions for ASP review. MethodsASP-audited adult pneumonia patients from January 2016 to December 2018 in SGH were included. Patient data e.g., demographics, allergies, past medical history, and relevant laboratory investigations at each antibiotic use episode were extracted from electronic medical records and re-assembled through linking for analysis. Ground truth for model training was based on ASP-defined appropriateness for each encounter. The dataset was split into 80% and 20% for training and testing respectively. Three modelling techniques, XGBoost, decision tree and logistic regression, were assessed for their relative performance in terms of precision, sensitivity and specificity. ResultsThere were 12471 unique patient encounters. Training was done on 10459 encounters and 39 data elements were included. When tested on 2012 encounters, the logistic regression model performed the best (86.7% sensitivity, 71.4% specificity). The model correctly classified 1377 out of 1388 (99.2%) encounters as “appropriate” (do not require ASP intervention). 624 antibiotic use encounters were classified as “inappropriate”, of which only 72 were truly inappropriate (positive predictive value for ASP intervention, PPV 11.5%). The low PPV was likely due to inadequate representation of “inappropriate” cases in the training dataset (4.1%). Applying this model would prioritise the number of immediate ASP reviews needed to identify cases for intervention by two-thirds, from 2012 to 624 (Figure 1). Figure 1. Illustration of AI benefits in ASP ConclusionASPs can leverage on machine learning capabilities to improve audit efficiency. This can increase ASP’s productivity and staff’s job satisfaction as they are freed up to perform other work. Disclosures All Authors: No reported disclosures

Is Hospital Autopsy Auditing Suitable for Clinical Risk Manage ment? Actualities and Perspectives of Auditing in the Autopsy Room Following Italian Law 24/2017 on Patient Safety.

Autopsy is a valuable tool for understanding the physiopathology of any disease, and it is the gold standard to assess the cause of death. The clinical autopsy is the ultimate medical service for a patient and plays a crucial role in the context of quality control, education of physicians and other medical personnel, as well as mitigation of risk of malpractice claims. This study aims to demonstrate the importance of improving an autopsy service and the relevance of this investigation procedure in daily clinical practice by evaluating the rate of major discrepancies between the assumed cause of death and the ascertained cause of death after a complete post mortem investigation. A further aim is to classify these discrepancies as class I or class II discrepancies according to the Goldman's criteria in order to assess performance quality. A retrospective study of the hospital autopsies performed from June 2018 to March 2020 was conducted by considering a diversified dataset, including age and sex of the deceased as well as the clinical and pathological causes of death. 362 cases were taken into consideration. Major discrepancies were found in 71.3% of cases, with a class I error of 22.7% and a class II error of 48.6%. The most frequent misdiagnosis were cardiovascular disorders, embolism, and aneurism rupture. The rate of major discrepancies and the rate of class I and class II errors are way above the rate found in the literature. Despite the high rate of a major discrepancy, evidence collected from hospital autopsies (i.e., certainty of the cause of death, unknown comorbidities) has strengthened the legal defense in cases of medical malpractice litigation. In our experience, by accurately determining the cause of death, revealing new or unexpected findings, and any possible diagnostic or technical errors, post-mortem examinations can significantly contribute to the improvement of team performance and quality of care. The presence of clinicians during an autopsy and the early sharing of results can be considered a new auditing strategy for hard clinical cases. Finally, by providing a clearer understanding of the nature and cause of the illness, the autopsy results assist in the grieving process by reassuring family members that action or inaction on their part had not contributed to the death.

Machine learning optimization of an electronic health record audit for heart failure in primary care.

AimsThe diagnosis of heart failure (HF) is an important problem in primary care. We previously demonstrated a 74% increase in registered HF diagnoses in primary care electronic health records (EHRs) following an extended audit procedure. What remains unclear is the accuracy of registered HF pre‐audit and which EHR variables are most important in the extended audit strategy. This study aims to describe the diagnostic HF classification sequence at different stages, assess general practitioner (GP) HF misclassification, and test the predictive performance of an optimized audit.Methods and resultsThis is a secondary analysis of the OSCAR‐HF study, a prospective observational trial including 51 participating GPs. OSCAR used an extended audit based on typical HF risk factors, signs, symptoms, and medications in GPs' EHR. This resulted in a list of possible HF patients, which participating GPs had to classify as HF or non‐HF. We compared registered HF diagnoses before and after GPs' assessment. For our analysis of audit performance, we used GPs' assessment of HF as primary outcome and audit queries as dichotomous predictor variables for a gradient boosted machine (GBM) decision tree algorithm and logistic regression model. Of the 18 011 patients eligible for the audit intervention, 4678 (26.0%) were identified as possible HF patients and submitted for GPs' assessment in the audit stage. There were 310 patients with registered HF before GP assessment, of whom 146 (47.1%) were judged not to have HF by their GP (over‐registration). There were 538 patients with registered HF after GP assessment, of whom 374 (69.5%) did not have registered HF before GP assessment (under‐registration). The GBM and logistic regression model had a comparable predictive performance (area under the curve of 0.70 [95% confidence interval 0.65–0.77] and 0.69 [95% confidence interval 0.64–0.75], respectively). This was not significantly impacted by reducing the set of predictor variables to the 10 most important variables identified in the GBM model (free‐text and coded cardiomyopathy, ischaemic heart disease and atrial fibrillation, digoxin, mineralocorticoid receptor antagonists, and combinations of renin‐angiotensin system inhibitors and beta‐blockers with diuretics). This optimized query set was enough to identify 86% (n = 461/538) of GPs' self‐assessed HF population with a 33% reduction (n = 1537/4678) in screening caseload.ConclusionsDiagnostic coding of HF in primary care health records is inaccurate with a high degree of under‐registration and over‐registration. An optimized query set enabled identification of more than 80% of GPs' self‐assessed HF population.

Female audit team leaders and audit effort

Auditing is a collective process conducted by a professional accounting team with a wide range of skills and experience. Audit work is labor-intensive, and audit team diversity, particularly gender diversity, is considered to have both auditing and economic effects. However, there is scant empirical research on the way that audit engagements are conducted and the role of audit team leaders (ATLs), specifically female ATLs, in the audit effort, because they and other audit team members mainly develop audit strategies in practice during the planification period. A hand-collected private data set was gathered from Spanish small and medium-sized audit firms from 2001 to 2015. After controlling for endogeneity, the analysis shows a more efficient audit effort by female ATLs and their audit teams when task complexity increases. Furthermore, the findings show a masculinization process by female ATLs when their experience rises, which may be interpreted as intrinsic motivation for future promotions. Additional analyses also reveal differences in female ATLs’ behavior when there are shorter audit firm tenures and larger audit firm sizes. Overall, our empirical evidence is in line with the idea that gender diversity is positive for audit efficiency. Our study responds to calls from regulators to consider audit team attributes as a relevant factor in the quality of audit quality practices.